Sometimes the original plan is best, but the problem is that you never get to go back find out if you were right. With Lisa and I, it was love at first sight, and we had a lot in common. Both of us were divorced. Eight months after meeting, we got engaged and started to build a house together. In just over a year we were married and moved into our new home. We had planned to spend a year together before working on a new baby, to get some time to settle into married life. Then we changed our minds; we weren’t getting any younger, so we decided to forgo that year wait and started trying within the second month of marriage.
It took about a week of trying for us to get pregnant.
Even before Lisa got pregnant, we discussed postpartum depression. Lisa was pretty sure she had gone through a postpartum depression with her daughter 10 years ago. She was dealing with anxiety issues before that pregnancy which worsened afterwards. . She eventually started taking Paxil and went to counseling. She thought that the depression and anxiety contributed to her divorce. She started to feel some of the same anxiety at the beginning of the pregnancy, so Lisa’s OB/GYN suggested she go back on to Paxil during the pregnancy. Lisa was concerned that the Paxil might affect the baby and decided not to take it. After a few weeks this seemed to be a good idea because her anxiety subsided.
The pregnancy moved along rather uneventfully until the last month. Lisa developed an inconsolable rash called PUPPPS. She would itch uncontrollably, which would only allow her a couple of hours of sleep in a row at night at best. She was taking oatmeal baths almost constantly, and was trying all sorts of home remedies. Being pregnant prevented her from being able to take anything stronger. It got so bad that the OB/GYN considered inducing labor. The light at the end of the tunnel was that we knew that when she gave birth the rash was supposed to clear up almost immediately. Just as Lisa was at her wits end she went into labor.
Labor and delivery went well. As soon as the baby was born, Lisa immediately fell in love. She talked about how she wanted him to stay little, and how she hated this time when her daughter was born and now she loves it. I took a week of vacation and Lisa had the entire summer to recover so things were looking good.
During the week together with our son Bobby things seemed to be going okay at first. Then I noticed Lisa would get very anxious whenever Bobby cried. Then towards the end of the week Lisa started to get concerned that I was going back to work. I assured her that she had lots of help from family and friends if she needed it, but she was concerned about her being able to handle it on her own. When I went back to work, things got worse. Lisa didn’t seem to want my help with the baby, but she couldn’t handle everything on her own. The only people she seemed to trust with the baby were her Mom and her cousin Sara. Things finally came to a head on the Sunday after my first week back. Sunday morning Lisa’s mood degenerated into sheer panic. She couldn’t even eat. She wanted to get rid of our son. Fortunately, we were able to call her mother, Janet, who had an enormous amount of personal days available. She immediately moved in to help.
Even though Lisa started back on Paxil after delivery; it was obvious that it wasn’t working. The only thing we could do was try to get an appointment with a psychiatrist. We were finally able to get one on Tuesday. Until then, we could only wait.
The only thing we knew to do was go to the bookstore to try to find any information on PPD and try to get some sort of a plan for what to do. The book that showed the most promise talked about getting together with a team of postpartum experts led by a psychiatrist and psychologists working together to come up with a plan of attack. Unfortunately, we would find out that such an entity doesn’t exist.
The first Doctor’s visit we were able to obtain was atrocious. The doctor’s first words were, “Why are you so sad?” She prescribed Remoron and sent us on our way. When I tried to ask the pharmacist what the difference between Remoron and Paxil was he said that they were basically the same. I was even more furious. After, about 45 seconds of research on the Internet I found out that the two drugs were completely different drugs, in fact a completely different class of drugs. We knew that this doctor would not be the one we needed, she seemed to think it was no big deal. We scheduled another psychiatrist and got an appointment with a psychologist.
Things were getting worse and worse. Her mother and I worked together to make sure that Lisa would not be alone with the baby no matter what. Lisa didn’t want the baby. She would have a conversation over and over again with me about the plans for the future. She wanted me to leave with the baby. Then she suggested giving the baby away. Then she started worrying that her ex-husband would try to take her daughter away. Then she would talk about hiring a nanny, to give her mother a break. No amount of reassurance from her mother or me was able to calm her. At her worst she would hint at killing herself. Variations of this conversation would continue almost daily for months. Lisa was almost entirely bedridden.
Finally, we got a psychiatrist that seemed to care and Lisa started seeing a psychologist. While Lisa attitude wasn’t improving, she was at least able to eat once she started taking different medications. (From this point on Lisa was on such a changing cocktail of medications and I can’t even remember half of what she was taking.) According to the books, things should have started to look up. We had a good care plan for Bobby. He would never be left alone with Lisa. For the first few weeks her Mother was able to take time off work to stay at the house. After that, her Aunt Sue became the daytime babysitter, with her mother staying to help overnight.
Then the question was, “what is suicidal?” kept creeping in. During our walks to keep Lisa active and moving, she would say things like wanting to check out. She couldn’t take it anymore. I was on the phone with her psychiatrist and psychologist, asking if I needed to take her to the emergency room. In retrospect, they probably should have said yes.
It also didn’t help that she wasn’t responding much to any of the medication. Aside for a lessening of the severest panic attack, she still wasn’t responding to Bobby. She couldn’t see what everyone saw in him. I wondered what happened to the woman I fell in love with and married.
Frustration was setting in. It didn’t help that her psychiatrist and psychologist couldn’t seem to agree on a course of action. There was an outpatient-counseling program available that the psychologist seemed to think was very appropriate for her. The psychiatrist didn’t seem to think that it would do any good, especially right then since she wasn’t responding to any medication.
I decided I needed to talk with both the psychiatrist and psychologist a little more in detail. The psychologist seemed to say a lot of things that made sense, however a couple of things struck me as odd. First she seemed mad that the psychiatrist didn’t recommend the outpatient program. What struck me as worse was her general recommendation. She said that Lisa was not using logical thinking. She was using irrational emotional thinking, and that she needed to replace her irrational thinking with logical thinking. My mind screamed, “if she could do that, she wouldn’t be here!” When we got in the car Lisa told me how the psychologist kept yelling at her that she wasn’t trying hard enough. Again I thought if she could try harder she wouldn’t be there.
The visit to the psychiatrist went much better. He did a very good job of explaining what the medication was supposed to do. He also had the opinion that Lisa was in such bad shape, that no amount of counseling would help until the medication started to work. He also said that at some point, we might need to look at Electroshock treatment.
After seeing what both professionals had said I decided to put all our chips on the psychiatrist. At this point going to the psychologist seemed counter-productive. I also felt I had to protect my wife from all the well-meaning, but useless advice from friends and relatives. For some reason, people seem to think they are better experts at psychiatric medicine then the psychiatrists themselves. I’m of the opinion that advice gleaned from watching Dr. Phil or reading a self-help book or two, is no substitute for real medical training.
I should take this time to mention some other things that happened during the summer while we were going through the postpartum depression:
· Lisa’s mom had to have a shunt put in her renal artery. She kept this secret until the day of the procedure. It was supposed to be out patient, but when my wife took her, her mom passed out on the way back to the car, and Lisa thought she died. She was okay, but spent the overnight at the hospital.
· My mother was hospitalized for two weeks, with a toe infection (she was diabetic). The toe infection caused them to find out that she had blood clots in her leg.
· Lisa’s uncle was hospitalized for an aneurysm. He was deaf and had difficulties communicating, and Janet and her sisters had to go with him for his doctor’s visits.
· Another of Lisa’s aunt’s was moved to Hospice, as her congestive heart failure worsened.
· Lisa’s daughter Megan had to be rushed to the emergency room with an allergy induced double pneumonia.
No matter how bad it gets, things can always get worse.
After several months of attempts at getting medication to improve Lisa’s health with no appreciable improvement, the psychiatrist set up a course of Electroconvulsive Therapies at the Cleveland Clinic. Lisa was scared, but hopeful, since ECTs were supposed to be the strongest treatment available for clinical depression. The procedure was explained to us as follows: The ECTs are done while the patient is put under anesthesia. . The electricity creates a massive seizure, which releases all kinds of chemicals in the brain that would have the effect of stabilizing her mood. She would have to be admitted to the psych ward to run tests before the first procedure.
I had to leave her alone overnight. It was not pleasant. She would be getting her first treatment first thing in the morning. When I came to visit, she seemed to be tired, but happy. The doctors said that everything went well and that she could be discharged and get the remaining ECTs on an outpatient basis.
The next couple of weeks, she had 7 treatments. Her mother was able to take her in the mornings, and she could be home before 9am. After each treatment Lisa was exhausted. The doctor had said that she could do as much as she wanted on the in between days. (She was getting a treatment every other day) This wasn’t such good advice. She tried driving. This wasn’t good. After almost hitting some things, she avoided it as much as possible. She was also starting to dread the treatments. She could hear the patients next to her screaming before the treatments and the whole process was unsettling. She was also experiencing short-term memory loss, which is supposed to be the chief side effect.
Finally, the last ECT was done. Lisa was done with her ECTs she was experiencing the short-term memory loss and some disorientation, but she seemed to be doing well with the baby. Her mother starting talking about finally was getting to sleep at her own house. Then something strange started to happen.
Lisa started talking about work excessively. She kept saying that she forgot how to teach and she would never be able to go back to work in time, and that we would go broke, lose the house and she would lose her daughter. I called both her normal psychiatrist and the psychiatrist who conducted the ECTs. Both said this was normal and that the key was to keep her busy. “Get her crossword puzzles to fill her time up.”
That didn’t work and she kept getting repeatedly worrying that she would never teach again and all was lost. No matter what I did to reassure her, she couldn’t see anyway we could make it through her anxiety. Again I called to psychiatrists, they both said to reassure her and keep her occupied until the end of the week, when they would see her for a follow up. Everything would be fine.
Four days after her last ECT, I called home on the way from work to see how she was doing. First I talked to Aunt Sue, who said that the baby was fine, but Lisa was still not doing well. Lisa picked up the other line and Aunt Sue hung up.
“How are you doing?” I asked.
“I cut myself.”
“What do you mean you cut yourself?”
“I cut myself with scissors.”
My mind raced. I don’t remember what I said, but I decided I didn’t want to risk hanging up and letting Lisa do anything else to herself. I couldn’t gather any information on how badly she hurt herself, but I knew she was still conscious while I was talking to her.
As soon as I got home I raced upstairs. Lisa was sitting on the bed staring down at her arm. She had taken a pair of toenail scissors and scratched her arm. It was covered with ripped up skin and was very red. It looked terrible, but there was little blood. I asked her why she did this. She said, “Because you wouldn’t listen to me.” I told her to get ready to leave, and that we were going to the emergency room.
I went downstairs to tell Sue to stay over and call her sister, since I was taking Lisa to the emergency room.
The drive in the car was horrible. I couldn’t understand how Lisa could possibly say that I wasn’t listening to her, and I couldn’t believe that the best treatment that the psychiatric community could give led to this. We drove to the emergency room at the clinic where she received her treatments.
We were admitted to the ER pretty quickly. After routine checks she was getting set up with a room in the psych ward. I had talked to her doctor and he was going to follow up with her. I followed her up to her room in the psych ward as they wheeled her up there. And I waited. Finally, with information from the resident that she would be admitted for the forseeable future, I left to go home.
When I got home, I briefed her Mom on what was going on. She had already told my step-daughter that her mom had to go back to the hospital for awhile.
I went to bed and let myself cry.
Lisa ended up spending two weeks in the psych-ward. They adjusted her medication, and she started to seem calmer. I was still going to work and her mom was watching Bobby every night. I was able to get to the ward every day just as visiting hours started and was able to spend the entire time with Lisa. The first day or so, she pretty much stayed in her bed in the hospital gown and didn’t move too much. She complained that the doctors were against her. After a couple of days she started to lighten up a bit. I would get in early and see her acting outgoing with the other patients.
That Friday our priest visited and offered a blessing.
The days started to melt together. The next couple of weeks Lisa got somewhat better, although she was afraid to go home. It was very difficult to compare how she felt in the relative security of the psych-ward to how she would do with being back at home. After 10 days, the staff was starting to think that Lisa would soon be ready to go home. She was still worried that she had forgotten how to teach, but the sheer terror was gone. The staff asked that I bring our son, so that they could see how she interacted with her. When I brought him in he was the hit of the ward and Lisa actually looked like a mom again.
The doctors said that she could be going home soon, they also recommended Lisa go to a five-week out patient program. I was excited about both options. Lisa was doing a lot better, although she still did have some anxiety about going back to work. On the second Friday Lisa was in the ward, the staff had asked her if she thought she was ready to go home. She wanted to wait over the weekend. So they decided to keep her for the weekend.
What makes that noteworthy is that when I told this news to her mother, she said. “Well if I visit her I visit her. She chose to stay there.” I mentioned this, not to criticize her mother, but to point out how even those closest to the women going through postpartum depression can reach their limit. It’s something a husband needs to be guard against coming up within themselves. If you make failure an option when dealing with PPD, you will fail. She will make you furious, she will make you scared, she will make you want to cut your losses and take your children away from her. You must remember this is not her talking. She is sick, and you might be the only thing in the world that can keep her from killing herself, killing your child, or both. You need, and must take any and all support you can. You will need it, but when the rubber hits the road the responsibility may lie completely on your shoulders.
The outpatient program was long, sometimes it seemed not to be very useful, but in Lisa’s case it served several purposes. First, it gave more time with medical professionals dealing with her. Second, it allowed her to realize that if she couldn’t start working right when school started, that would be okay. She could take as long as she needed, and she wouldn’t lose her job, or her children. Last, and most important to me, was that she realized that hurting herself wasn’t a solution.
Let me explain. When Lisa got out of the hospital, she seemed okay, but she would occasionally make the statement, “Sometimes I feel like I’m going to hurt myself again.” It would typically come off as a veiled threat. I brought this up during the part of the program and they were able to explain how bad of an example that would send to her daughter. I never heard that again.
During the last week of the outpatient program Lisa decided to go back to work. She only missed a couple of weeks, but the time was invaluable to her getting into the right frame of mind to be able to teach.
It’s been about six months, as I write this, since she completed the outpatient program and Lisa is doing much better. Unfortunately, there are still challenges. One of the major difficulties, is people’s attitude towards PPD (and probably depression in general). There are still comments to the effect that what happened was somehow her fault and her failure. Just the other day someone told her, “You always seemed to be so put together.” Even her mother made the comment while Lisa was at her worst; “She’s being selfish.” Both comments are akin to telling someone with Alzheimer’s to stop being stupid, when they can’t remember. Also, Lisa is still seeing a psychiatrist every other week. She is still taking several medications, which make her tired, and have prevented her from losing much of the weight she gained during pregnancy. But she is back. The problems she has now are manageable. She is able to function, as a mother, a teacher, and a wife. We still have a long way to go to make sure that she stays healthy and gets stronger, she herself again.